LIVER HEPATOBILIARY

HPB SYSTEM – THE BILIARY TRACT

The biliary tract is made up of the gallbladder and bile ducts. The gallbladder is a pouch that connects to the mid-portion of the main bile duct, acting as a reservoir for bile while it is not being used for digestion. The main function of the bile duct is to transport bile, a liquid produced by the liver to the intestine where it helps with the digestion of food.

 

THE TWO MOST COMMON CONDITIONS AFFECTING THE BILE DUCT ARE BILE DUCT STONES AND BILE DUCT CANCER

Bile duct stones are caused by gallstones that may have fallen out into the main bile duct. And in rare instances, stones may form in the bile duct instead of the gallbladder. The risk factors for gallstone formation include obesity, female gender, pregnancy, high-fat diet and family history. Patients with this condition may experience symptoms of infection (fever, right upper abdominal pain, sweats and chills) as most stones contain bacteria that may lead to infection of the blocked bile flow. Gallstones in the gallbladder may be detected by an ultrasound scan of the abdomen. Gallstones are very common in the general populations and the presence of the gallstones without symptoms usually does not require treatment. Stones in the bile duct, however, require medical attention.

Stones in the bile duct may be removed using a special endoscope called endoscopic retrograde cholangiopancreatography (ERCP). Introduced through the mouth, a flexible tube with a light and camera goes into the duodenum where the bile duct is to remove the stones. If the ERCP is unsuccessful in removing the stones, a radiological procedure is suggested for percutaneous transhepatic cholangiogram to be performed where a catheter is inserted through the liver into the bile ducts for the visualization of the biliary tract.

Another option is to perform a surgical removal of the bile duct stones. In order for bile duct stones to be removed from the gallbladder, the gallbladder will be surgically removed, often via key-hole or laparoscopic technique, to prevent recurrent problems.

 

DID YOU KNOW?

Our body sends signals when the organs are malfunctioning. Symptoms do not always relate to the seriousness of your disease. You may have no symptoms at all and have severe heart disease, requiring prompt treatment. People often take a wait-and-see approach, delaying because they think that what they are feeling is due to something else.

BILE DUCT CANCER

Bile duct cancer, or cancer of the wall of the bile duct, may occur along the course of the ducts. Its risk factors include parasitic infection, primary sclerosing cholangitis (autoimmune bile duct inflammation), bile duct cysts and chronic bile duct stones. Patients with this condition may complain of poor appetite, weight loss and fatigue.

Such cancer is difficult to detect at its infancy and usually has no symptoms. It may cause an elevation of tumour markers but because tumour markers are also commonly raised in noncancerous conditions, it is often difficult to identify such cancer.

Surgical removal is the only chance for cure in bile duct cancer. Surgery is only possible if the patient is diagnosed at an early stage before the cancer has spread. The type of surgery is dependent on the location of the bile duct cancer and it usually involves the removal of the bile ducts with part of the liver or pancreas.

After recovery from surgery, it is often recommended that patients undergo chemotherapy and/or radiotherapy. If surgery is not possible, chemotherapy may prolong the patient’s survival.

 

DOCTOR IN CHARGE

Dr. David Khoo Sin Keat

Dr. David Khoo Sin Keat

Consultant Cardiovascular & Thoracic Surgeon

Dato Dr. Tan Kai Chah

Dato Dr. Tan Kai Chah

Consultant Hepatobiliary & Liver Transplant Surgeon

Dr. Yap Yee Guan

Dr. Yap Yee Guan

Consultant Interventional Cardiologist

Dr. Chong Yoon Sin

Dr. Chong Yoon Sin

Consultant Interventional Cardiologist

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